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《2010BTS英國胸科學會胸膜疾病指南：惡性胸腔積液》內容預覽

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The discovery of malignant cells in pleural ?uidand/or parietal pleura signi?es disseminated oradvanced disease and a reduced life expectancy inpatients with cancer.

Median survival followingdiagnosis ranges from 3 to 12 months and isdependent on the stage and type of the underlyingmalignancy. The shortest survival time is observedin malignant effusions secondary to lung cancerand the longest in ovarian cancer, while malignanteffusions due to an unknown primary have anintermediate survival time.

Historically, studiesshowed that median survival times in effusions dueto carcinoma of the breast are 5e6 months.However, more recent studies have suggestedlonger survival times of up to 15 months.
comparison of survival times in breast cancereffusions in published studies to 1994 calculateda median survival of 11 months.
Currently, lung cancer is the most commonmetastatic tumour to the pleura in men and breastcancer in women.
Together, both malignanciesaccount for 50e65% of all malignant effusions(table 1). Lymphomas, tumours of the genito-urinary tract and gastrointestinal tract account fora further 25%.

Pleural effusions from anunknown primary are responsible for 7e15% of allmalignant pleural effusions.
Few studies haveestimated the proportion of pleural effusions due tomesothelioma: studies from 1975, 1985 and 1987identi?ed mesothelioma in 1/271, 3/472 and 22/592patients, respectively, but there are no more recentdata to update this in light of the increasing inci-dence of mesothelioma.
Attempts have been made to predict survivalbased on the clinical characteristics of pleural ?uid.None has shown a de?nite correlation: a recentsystematic review of studies including 433 patientsassessing the predictive value of pH concluded thatlow pH does not reliably predict a survival of <3months.
In malignant mesothelioma, onestudy has shown an association between increasingpH and increasing survival.
Burrows et al showedthat only performance status was signi?cantlyassociated with mortality: median survival was1.1 months with a Karnofsky score <30 and13.2 months with a score >70.

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